Abstract
Background: COVID-19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino-orbital mucormycosis in patients with COVID-19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID-19 associated with mucormycosis infection.
Methods: The medical records of COVID-19 patients with rhino-orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics.
Results: Twelve patients with COVID-19-associated rhino-orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID-19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy-five per cent of patients received corticosteroids for COVID- 19 treatment. The sites of involvement were rhino-sino-orbital (83%) and rhino-sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first-line therapy. The overall mortality rate was 66.7% (8/12).
Conclusions: We found a high incidence of mucormycosis among COVID-19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life-threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed.
Keywords: COVID-19; Iran; SARS-CoV-2; co-infection; mucormycosis.
【저자키워드】 COVID-19, SARS-CoV-2, Iran, Mucormycosis, Co-infection, 【초록키워드】 Corticosteroid, Treatment, therapy, Risk factors, Prognosis, hospital, Infection, Diabetes Mellitus, Immunocompromised patients, Diagnosis, Symptom, surgical, hypertension, COVID, clinical manifestations, Mucormycosis, therapeutic, Patient, Complication, laboratory characteristics, incidence, fungal infections, hospitalisation, COVID-19 patients, Bacterial, Combination, Frequency, COVID-19 patient, Fungal infection, high risk, medical record, Diabetic, Amphotericin, overall mortality, life-threatening, physician, parameter, dominant, Affect, performed, was used, reported, the patient, diagnosed, the disease, analysed, Imam, Kermanshah, patients with COVID-19, 【제목키워드】 COVID-19 pandemic, hospital, Mucormycosis, therapeutic, incidence, Increased,